Horizon Care (South West) Ltd

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question Inadequate. At this assessment the rating has changed to Requires Improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in breach of legal regulation in relation to people’s safe care and treatment and person-centred care.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

At the previous assessment some people reported a lack of compassion from care staff and told us staff were always rushed and did not engage. At this assessment people were consistently positive about the caring approach and engagement of care staff. People described them as kind, respectful and patient, with many highlighting the positive relationships they had developed. Comments included, “Very caring staff. They show it by natural warmth and how they talk to me. They ask if I am okay and if I slept well, they just really care” and “They make time to talk to me, not just rush off.”

Overall people were more positive about the responsiveness of office staff to any issues or concerns raised. They told us, “I’ve never needed to make a complaint. I would contact the office who are always very helpful, I can panic a bit if times change and they will always check for me” and” The office will respond if we need times changing to manage appointments and they will visit earlier at our request.”

External professionals reported positive and open engagement with the service.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, and protected characteristics.

Since coming into post the registered manager had begun completing risk assessments and reviewing care plans with people using the service. These reviews were undertaken face to face with people and, where appropriate, their relatives to ensure their views, wishes and preferences were captured. The newly completed care plans contained information about people’s likes and dislikes and how they wished their care to be delivered. However, they did not consistently consider how people’s protected characteristics under the Equality Act 2010 may impact on care provision. Information relating to cultural background, religious beliefs, gender identity or sexual orientation was not routinely explored or documented. This meant care planning did not fully demonstrate how care would be adapted to meet people’s individual equality, diversity and inclusion needs.

The introduction of a new electronic operating system meant that daily care records were required to be more detailed and clearly document the care provided and any issues identified. This improvement enabled information to be shared more effectively across the service and provided the registered manager and provider with improved oversight of the quality and safety of care. As a result, there was greater assurance that care delivered was monitored and aligned with people’s assessed needs and stated preferences.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

At our previous assessment people told us they had limited control over when their visits were scheduled or delivered, or which carers supported them. At this assessment we found there had been some improvements, however, this remained a significant issue for some people we spoke with. One person told us how care staff had arrived earlier than expected when they were still asleep, which meant they were unable to take their planned shower or take their medication at the correct time. Another person said, “To be honest the care is absolutely fine. It is the office and the rota planning that is useless.”

At the time of our assessment, the service was in the process of completing risk assessments and reviewing care plans with people. As a result, people were beginning to experience greater choice and control over how their care was delivered. In addition, care staff had been instructed to ‘slow down ‘and spend time with people to promote wellbeing and reduce social isolation. This work was ongoing and improvements were in the process of being embedded.

Staff had completed training in the Mental Capacity Act 2005 (MCA) and understood the importance of gaining consent before providing care. However, staff at all levels of the organisation did not demonstrate an understanding of how the legislation protected people’s rights when they lacked capacity to make specific decisions for themselves. Staff comments included, “Yes, I did MCA training. I can't remember much of what the training was. It was about how to support mentally with our clients” and “Mental capacity is a new training course. I enjoyed it. No, I can’t really say something that I learned from the training. I would be able to recognise if a person lacks capacity. The information is in the care plan. “

Despite these concerns people told us care staff promoted their independence. Comments included, “They help me do things for myself and don’t just do everything for me” and “They very much encourage my independence whenever they can, which is good.”
 

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Care staff did not always have sufficient guidance to enable them to recognise changes in people’s needs and respond appropriately in the moment. At the time of our assessment the majority of people did not have an up-to-date risk assessment or care plan uploaded to the electronic operating system. Where care plans had been reviewed, they did not consistently provide clear guidance for staff on how to respond to specific health conditions. This included, for example, high or low blood sugar levels for people with diabetes, or responding to skin breakdown for people at risk of pressure damage.

There were no protocols in place to support staff in identifying when ‘as required’ medications should be administered. For example, the use of paracetamol for pain relief.

During the assessment we saw examples of where care staff had not always responded to people’s immediate needs or escalated concerns appropriately. For example, following a fall and head injury, or where a person had an episode of incontinence.

Despite these concerns people were confident the staff supporting them would recognise when they needed additional support and take appropriate action. Comments included, ““They notice if something is not quite right. I have every confidence that they would contact a doctor should I need one” and “If I was unwell, I’m sure they would react.” In addition, the provider’s falls audit demonstrated that where care staff had escalated concerns to the office following incidents, external health support had been contacted where appropriate.
 

The provider cared about and promoted the wellbeing of their staff. They were developing support systems to enable staff to deliver person-centred care.

Since coming into post the registered manager had taken proactive steps to improve the wellbeing of care staff and ensure they received the support required to deliver safe and effective care. The provider’s service improvement plan identified a range of actions aimed at strengthening staff support and practice, which were in the process of being implemented at the time of the assessment.

These actions included the introduction of paid travel time between visits, increased training opportunities and the introduction of regular 1 to 1 supervision and reflective practice to support staff development and wellbeing. However, at the time of our assessment these improvements were not yet fully embedded and their effectiveness in improving outcomes for people could not yet be consistently demonstrated.

Staff meetings had been held to introduce the new registered manager and the changes being introduced, such as the new electronic operating systems and expectations of the staff team. Records showed staff had been encouraged to ask questions and voice any concerns and were thanked for all that they were doing.

We received positive feedback from staff about the increased support they had received since the registered manager came into post. Comments included, “ Managers are supportive, they are approachable and always willing to listen, they step in where there are concerns about clients or staff and provide clear guidance and expectations” and “ I have seen a number of changes since your inspection namely the bringing in of a new manager who has implemented a number of measures, and is still working on that, She managed to have face to face meetings with staff and sent an email regarding where we needed to improve, and to keep on doing good work as far as care is concerned.”